Non-Medical Interventions for ADHD

Let's look at the three groups of problems, attention, impulsiveness, and hyperactivity. For attention, there are many things that can be done. The most important by far is to cut down distractions, both sights and sounds. People with ADHD can not ignore unimportant sounds and sights as well as everyone else. So one strategy is to reduce these distractions as much as possible. At home, that means if you are asking a child with ADHD to do something, ask it in front of his or her face. She should be in a room with the TV and Radio off. There should not be a lot of other action going on. This may mean actually taking him into another room before you tell him what to do. In school, this means finding a place in the class that is the least distracting. This usually is close to the teacher or away from other disruptive kids, windows, and doors. When doing homework it means finding a place that is quiet and dull. Doing homework on a kitchen table with lots of stuff on it will just not work with kids like this.

Another key area is to use rehearsed listening strategies. Most of us do this all the time. Rather than just come out and say some key thing to a family member we first say, "Listen up" "dinner is in five minutes so go and wash your hands". With people who have ADHD, you need to be much more formal and more consistent. EVERYtime you want the person to pay attention, you should first start with some well learned cue like, "Listen up". Sometimes this will be helpful, and sometimes not.

Another strategy is to use more than one sense at a time. In the home, I would not tell a child with ADHD to go clean their room and put away their clothes. I would write it down on a little blackboard in their room and say it at the same time. Likewise in school, rather than say get out your blue scribbler, I would write those words and say it. Combining written and oral instructions can often lead to better attention.

Another thing that can work is to use interactive learning. Rather than worksheets for learning adding, you could try using some simple computer programs which can hold a child's attention far better, especially when ADHD is present. Any program which has a lot of action plus learning can be very useful.

Make life more structured at school and at home. When things are always happening at different times, you have to pay a lot more attention to figure out what you should do next. Many kids with ADHD will do better if they know that every day they can play at a certain time, do certain chores at a certain time, homework at another time, and eat and sleep at a predictable time. This lessens the need to pay as much attention.

Lack of sleep will make anyone less attentive, and kids with ADHD are sometimes very susceptible to this. There is a group of ADHD kids who are easily over stimulated and as a result do not get enough sleep. Regular bedtimes and calm activities before bed sometimes help. If this problem is severe this may be a reason to consider medications, as poor sleep makes poor attention.

That may help the attention, but what about doing things without thinking? What can be done to the environment to help this?

The essence of impulsiveness is that when people have the opportunity to do something stupid, they do it without realizing the consequences. Environmental changes focus on reducing the opportunity to do something stupid.

Most impulsive acts occur during unstructured time in the home and at school. So one environmental change to make is decrease unstructured time. At home, this may mean that rather than letting a ADHD child just go play all afternoon, you plug him into some supervised activities - with family, with groups like girl guides and the YMCA, Church groups, and anything else you can find which fits the child's interests and yours but which has structure. At school it means coming up with a plan for recess so that the child is busy in a structured activity he likes - sports, helping someone, helping to fix something or the like.

Another idea is to avoid idle time as much as possible. Standing quietly in line for meals, standing in line to check out books and the like is part of life in a school. Kids with ADHD find this a great time to do stupid things which get them in trouble. One idea might be to let the ADHD child do something else for a while first to reduce this time in the line. Time waiting at checkout counters, repair shops, and waiting for one's turn on choice toys at home are also ripe for intervention. I would try to decrease this sort of thing as much as possible, as it is just too much to expect an ADHD child to do well in these sorts of environments.

Supervision. Kids with ADHD need to be watched like hawks so they don't do stupid stuff. Even though a child is 10, they may still have to be watched like they were four. You must supply the impulse control that is missing.

What about being hyper? My child isn't so impulsive, she just can not stop for a minute.

People with ADHD get restless very fast and that has to be kept in mind. An ADHD child may experience sitting still for 10 minutes in the same way a normal child will experience sitting still for 50 minutes. If you want to do get these children to sit still you need to make it for very short periods of time.

When the sitting still time is over they need to be given time to get up and do something - walk around the room, go outside, whatever. Trying to get a restless child to sit beyond their ability rarely works.

Make sure they have plenty of time for recess and never use the restriction of recess as a consequence for bad behavior. Children with ADHD need to blow off steam.

When a child is out zooming around, make sure they have extra time to cool down. Kids with ADHD do not quickly go from running to sitting quietly. An in-between activity is often useful.

Find the right sport or physical activity for the ADHD child to be involved in. One big plus of having ADHD is that you have a lot of energy. Kids with this make great athletes if it is the right sport. Not usually baseball, but soccer, hockey, swimming, biking, making camps, running and other high activity sports are a great idea to burn off some energy.

Children with ADHD do especially poor in chaotic homes. They actually react more severely than normal children. Abusive relatives, fighting or absent parents, custody battles, substance abuse, poverty, and bad housing will make ADHD worse. If these are present, everything possible should be done to alleviate them.

Limit Television

Television is a major force in our lives. Study after study has shown that Television is filled with violence, drug and alcohol use, and sexuality. The average child spends at least 2-3 hours a day watching this stuff. Many children spend 4-6 hours a day watching this. It should not be any wonder then that children who watch a lot of TV are more violent, are more likely to do drugs, and are preoccupied with sex. In a child with a problem like ADHD or ODD, this is clearly something that needs to be done. The American academy of Pediatrics recommends the following: (16)

Limit all media use to no more than 1 to 2 hours per day.
Monitor their children's use of the media.
Coview television with their children.

It also goes without saying that it is impossible to limit children's viewing if the parents are watching Television or playing video games all day and night. Turning off the TV is the most effective but radical solution to a host of child psychiatric problems. My advice is to be radical and do it!

Eliminate or reduce video and Computer games

Anyone who has ever seen a child play nintendo can see that there is a very potent force at work here. Unfortunately, the vast majority of computer and video games are violent and are becoming more graphic, not less, in their depiction of violence. As mentioned above, large amounts of television viewing can cause increased psychiatric problems for children. Although there is a less research on games, the same trend is there.

About 33% of children play computer or video games.(11) As anyone who has a child knows, these games can be very addictive. One out of five children from grades 5-8 are as addicted to computer games as an alcoholic is to alcohol.(10) The earlier children start playing these games, the more likely they are to get addicted. Children who play lots of video and computer games aren't as nice to others. Children who play violent games are more physically aggressive and are not as intelligent.(12) Unfortunately, the question remains whether or not children who are aggressive and have problems are attracted to these games or whether the games make them that way. With TV, the evidence suggests that violence on TV makes more violent kids. Given that video and computer games are a much more powerful medium than TV, I think it is quite safe to assume that they are having a detrimental effect on children.

Behavior Modification

The idea behind behavior modification is that even though there is something wrong with the brain in ADHD, if people are strongly motivated, they can in part make up for this deficit. In other words, if a person had a really good reason, they would try their very best to sit still, listen, and think before acting.

Is that what "1-2-3 Magic" is?

Yes, that is a good example. For behavior modification to work, the program must have certain properties:

1. A few important behaviors need to be targeted. Rather than targeting "being good", you might try no hitting and no swearing.

2. The behavior must be clear cut and not fuzzy. Things like "listen when I tell you something" won't work, because it is too unclear. A better idea would be sit down and look at me when I ask you to listen"

3. It must be consistent. There is no bending of rules in this sort of thing, no difference between the baby-sitter, mom, or dad.

4. The rewards and punishments need to be geared to the individual.

5. The rewards should not be money or things that are bought, but rather privileges which you can grant or activities which the child can do. Behavior Mod should not require a bank loan.

6. There needs to be an even mix of negative and positive reinforcers. The program should not be like candyland, but it also should not be out of Dorchester Prison . A typical Positive one would be a later bedtime on the weekend or a choice of dinner. A typical negative one would be going to your room or no TV.

7. It should be simple and straightforward so that your child easily understands it.

Almost every book on ADHD contains many good examples of these programs.

Here are some examples of good and bad behavior modification programs:

Jim never comes home when he is supposed to. This drives his parents nuts and they would like to kill him when he finally does come home. The behavior they want is "comes home on time".

The good parents The positive reinforcer (the carrot) would be if he comes home on time for 5 days, he can have a friend stay over and they can stay up late. The negative reinforcer (the stick) would be that If you are more than 5 minutes late, you will not be able to go out by yourself the next day. You will have to go out with me. (Remember, you don't want to restrict outside activities totally)

The Candyland parents If you come home on time, we will pay you five dollars or you will be able to stay up as late as you want at our house that night. If you don't come home, nothing bad will happen.

The Dorchester Prison Parents If you are one minute late, you will be grounded for a week to your room.

I tried all of these. It worked for awhile and then it stopped working. What happened?

Behavior Modification doesn't work for everyone. Sometimes you have to keep changing it all the time. It works best when you find the perfect reinforcers, positive or negative. A lot of people just don't have anything they are willing to try that hard for. Also, many people are so severely impaired they just can not benefit from this.

One to one Supervision

If you stay with a person with ADHD, you can sometimes do for them what their brains can not. Most people with ADHD can not pay attention to boring things like work or schoolwork for very long. If left to do their homework it takes forever. Sometimes by sitting with them you can bring their attention back to what they are supposed to be doing and help keep their mind from wandering. This is probably the most frequently used intervention of all. Most children with ADHD will do amazingly better in school if they have one on one teaching all the time and their parents sit with them to keep them on task for their homework.

So why do all these other complicated things?

Because there are few human beings who can stand to do this sort of thing for very long. Continuing to bring people's attention back to the task at hand is hard, hard work. It requires a huge amount of patience, resolve, and determination. Secondly, the person with ADHD often interprets this as nagging, and gets mad at the person who is trying to help them. Thirdly, it does not exactly promote independence. Nevertheless, it is the backbone of all non-medical interventions.

Does it help the other signs of ADHD, too?

It certainly does. When people are doing things one-to one with a caring adult, they don't get into a lot of trouble, their hyperactivity can be put to good use, and it is hard to get too impulsive. For example, a boy with ADHD might get into a lot of trouble in the village by himself or with peers. But if he spent the same amount of time out in the woods setting snares with his Dad, Grandpa, or Uncle, he would be putting all that energy to good use and would most likely not get into trouble.

I couldn't possibly keep up with this child! When we go to the playground I am exhausted long before he is!

Look for someone in your circle of friends and family who might not be. Is there some other person who would like to take your child out to do something which requires lots of energy a couple times a week?

I have three other kids. I just don't have that kind of time.

You may not, but maybe someone else who cares for the child does. But then again, maybe not. Sometimes this is just impossible to do.

Social Skills Interventions

My daughter with ADHD is 13, but she has the social skills of an 8 year old. What can you do about that?

It is very true that social skills are often very poor in ADHD. Poor attention, bad impulse control, and hyperactivity do interfere with the acquisition of social skills.

How do you teach social skills?

What doesn't work is teaching them social skills like you teach piano, reading, or math. People have tried to teach social skills in special groups but by and large, the social skills they learn in these special groups do not get used outside the groups.

What does work?

Putting your child in a group where there is a need for social skills, but not extremely good social skills. The best social skills are required for the most unstructured settings, like recess. You have to find some one to play with who wants to play with you, compromise on what to do, share, take turns talking, and control your temper if something frustrates you so you don't spoil the relationship in the future.

Groups should be:

1. Structured. There should be a definite end and beginning and a fairly predictable course.

2. Thematic Only certain interests are pursued by the group. If you go one week for bible study, the next week won't be hunting safety.

3. Geared to your child's interest. Children will be much more motivated to participate socially in something they are interested in.

4. Fun. Even if it is up their line, if it is boring to the child or too hard, they will not socialize more, and they won't learn social skills.

5. Not a burden to you. Not too far, Not too much money, Not on all the wrong nights and times.

6. Flexible. A completely rigid group may not work.

So what are some ideas?

Church youth groups, sports teams like hockey, baseball, soccer, basketball, volleyball and others, Computer clubs, Activities through the YMCA, art classes, dancing lessons, martial arts classes, the auxiliary of the Red Cross and RCMP, bands, choirs, Hunting clubs, Scouts, Girl guides, Some day care, School groups, swim team, sparks, beavers.

What should we avoid?

Doing nothing. The easiest thing to do with kids who have bad social skills is to let them be. It is hard to get them involved with other kids because there can be problems and complaints. It is easy to let them just be by themselves.

The result is that the child will find a bunch of other people with very bad social skills who you would rather not have as your child's friends. They remain socially retarded, frustrated, and depressed

Will medications improve social skills?

Yes, they will. But, the dose has to be enough and, in the case of Stimulants, it has to be given three times a day, seven days a week. The saddest thing I see is when I child is placed on just enough medicine to get them through school, but not enough to help them with their social skills.

Getting someone to help you parent

I have tried everything from groups to medicines and I seriously can not imagine going on like this for ten more years. What should I do, give up my son?

No! Some children with ADHD and more children who have ADHD in addition to other psychiatric problems can require an incredible amount of patience, energy, and determination. Often this is more than any one or two human beings can provide. There is no natural law that states that all children can be managed by one or two reasonable parents. Many children are born who require three to five full time parents. You may have one!

What you should do is everything you can to share the parenting. First think who in your family can take care of this child reasonably well for an hour? a day? a weekend? a week? Often there are cousins, aunts, uncles, good friends, fathers, mothers, or grandparents who can take a disturbed child for awhile, but not a long while. By putting a few of these together, you can get a little breathing space.

My family lives in New Brunswick, and my husband's family hates us.

The next step is to try what is available publicly. Daycare for little kids? After school programs for older kids? Big brother and big Sisters?

The last step is respite foster care on a regular basis. In some cases, this is the best way to go, as it will give you a chance to catch your breath and not go crazy.

The most common mistake people make in this situation is to think they should be able to do it all themselves. They then either end up giving up the child or getting so mad at the child that it would have been better if they had given it up. So don't be proud, get some help.

Dietary Interventions

What about diet? I have heard that diet can control ADHD.

Many people have claimed that different diets will control ADHD, and in the last few years some good research has helped clear this up. Sugar and Aspartamate (an artificial sweetener) do not make children with ADHD worse, even in large doses. However, a number of studies have shown that food coloring, preservatives, and additives do cause a worsening of ADHD symptoms in some children. (51)

Does it really make that much difference?

Imagine two groups of children with ADHD. In the first group, you give them artificial food coloring. In the second group, you stop their medications for ADHD. What happens? The children who had their ADHD medications stopped get a lot worse, say 70% worse. The children who take food coloring are about 30% worse. This suggests that at the very best, eliminating food coloring from the diet might make children 30% better. (51)

It isn’t just ADHD symptoms that worsen with food coloring. These children who take food coloring have insomnia and are much more irritable. This means that it might be reasonable to try and eliminate junk food and other items that show these things on the label. (51)

Almost everything has those things on the label!

That means making things from scratch, plus more fresh vegetables and fruits. Try making homemade cookies for treats instead of store bought goodies. I would use pure juice, milk or water for drinks. Many people forget about Kool-aid and popsicles. These are full of colorings. I would try to make my own meals from scratch rather than buy pre-packaged and already prepared meals.

My daughter is already a picky eater. This sounds like torture.

I would try it for a week or so. All the studies have shown that if it works, it will work in that amount of time or never.

We hardly eat anything that is pre-prepared. Should I eliminate these things completely?

No, if your child's diet is low in foods containing the above things, you can assume that this is not the problem. Try some of the other suggestions here.

Breakfast and ADHD

On the other hand, there is good data to support the importance of breakfast in children. Children who eat a breakfast do better in school, pay attention better, and get better grades. (18) The importance of this "dietary intervention" is much more important than additives or colorings. This may mean the breakfast is a sandwich or a glass of instant breakfast for an ADHD child. It is worth doing.

Family interactions and ADHD

How does the family affect the symptoms and signs of ADHD?

Many studies have clearly shown that what happens between family members can worsen ADHD or improve it. First, the relationship between the ADHD child and the parent can affect his symptoms. If the parent is absent much of the time, is inconsistent, drinking, or preoccupied with other problems, the symptoms of ADHD will be worse. If the parent sees the child with ADHD as her best friend and gives into everything eventually, the symptoms will be worse. On the other hand, hard, cruel and abusive parenting will also worsen ADHD. Parents who have ADHD themselves, bad tempers, or difficult personalities can sometimes cause a worsening of ADHD.

Second, the relationship between the parents/caregivers can worsen ADHD. Fighting between partners, multiple significant others, and custody battles can often cause ADHD to worsen. Another problem can be when the parents are not equal. A family should run with the parents in charge and the children under their authority. If in reality, one parent is in charge and the other parent is either below that parent, there will be worse problems with an ADHD child. Sometimes a family will be set up such that certain children have greater authority than a parent. Obviously this will make ADHD a lot worse.

It is also clear that the siblings of a child with ADHD will be affected. They have more behavior problems themselves, have more trouble in school, and don't get along as well in general.

If these family problems are present to any degree, they need to be sorted out as part of the treatment package. Family therapy is not fun. It is time consuming. However, if the family is quite dysfunctional, all of these other interventions are likely to fail or be only partially effective.

When my daughter is around, our family is quite dysfunctional. But once she leaves, my husband and I and our other two children get along fine. Does this mean we need family therapy?

No, it does not. One of the hardest things to figure out in child psychiatry is whether or not family problems are causing the disturbance or whether the psychiatrically disturbed child is causing the family to have problems. It can be either or both. Studies have found that it is just as stressful to be the parent of a aggressive ADHD child as it is to be the parent of an autistic child. When it is impossible to say what is causing what, I usually error on the side of assuming that the family dysfunction is caused by the psychiatrically disturbed child. I would therefore try treating the child first and see what happens to the family. My reasoning is that it is far easier to treat children with ADHD than it is to do family therapy. Secondly, there is not a lot of evidence to support using family therapy as a primary intervention in ADHD. So, if I can't tell what the problem is, I go with the other treatments.

If you are living with an aggressive child with ADHD, it will screw up your family to a certain degree. Sometimes, even a child with ADHD who is not aggressive will cause turmoil in the family.

Many family members, neighbors, and some professionals will assume that if a child is disturbed, then the family must be the problem. They rarely consider that it could go the other way, too. If some of the children I see with ADHD were placed in my family without any treatments, I am sure that our family would look very chaotic and dysfunctional, too.

Enhancing the child's strengths

All of the interventions discussed above are directed at the disabling signs and symptoms of ADHD. While working on reducing these signs and symptoms is important, it is just as important to find out what your child is naturally good at and make him even better at it. ADHD does a real job on a person's self esteem. Most children with ADHD will be spending a lot of time doing what is not naturally easy for them - going to school, staying out of trouble, and getting along with others, etc. They need to also spend time doing what they like to do and do well.

I see a lot of children whose self-esteem remains intact even though they have ADHD because they are naturally good at something and their caregivers have encouraged this. Here is a brief example:

Crystal

Crystal is 10 years old and has ADHD and a learning Disability. With a combination of a number of the different interventions noted above, she is doing better, but it is still not easy. Once she gave all her dolls new hairstyles with a scissors and Crystal's mother just about went through the roof. Luckily, Crystal's Aunt was there and thought that Crystal had some real potential in this area. So Crystal went to a friend's hair salon and learned about cutting hair. She loved it, and was good at it. Now she cuts her brothers and her mothers hair every two weeks and helps out some Saturdays at the hair salon.

Chris

Chris loves Power Rangers. He is constantly doing those moves and hurting other kids and knocking stuff over. His mother will not allow him to watch it. His Grandpa suggested maybe he should sign up for Karate. Chris was interested and did well.

Almost everyone is better than most people at something. The trick is to find that thing. When children with ADHD are severely impaired, this is hardly the most important thing. But as they improve some, start thinking about it. Sometimes it takes a little creativity or someone outside the immediate family to see what the child is good at. It is sometimes difficult to think of sending a child to art classes when they are in danger of failing school and in a lot of trouble. However, if that is what they are good at and can stick with, it will help their self-esteem a lot.

Here are some things to think about. Are they naturally good at sports? collecting things? music? computers? sewing? cooking? gardening? building things out of wood?( balsa wood is great for ADHD kids), drawing? fixing things? working with little kids? finding their way around? dancing? acting? martial arts? drawing monsters? writing horror stories? working in the woods? Working on the water?

In the end,

You will have the best luck helping your child with ADHD if you-
Look at all these possible interventions. Don't just rely on one thing.
Realize that you may have to consider doing some things which swore you would never do.
Realize you may have to move mountains to get things to happen
Talk with other people who have similar problems - ADHD support groups. there are support groups in Digby and Yarmouth. There is also a national organization called CHADD (Children and Adults with ADHD). The address is PO Box 23007, Ottawa, Ontario K2A 4E2.

Read other books about ADHD. The support groups have some. I have some, and I have a catalog of books on ADHD. Or, you can get the catalog yourself. It is called ADD Warehouse. Their address is 300 Northwest 70th Ave, Suite 102, Plantation, Florida 33317.